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The Regulation sets out a number of ​​activities that do not require an order if those activities are to:

  • Assess a client.
  • Improve or resolve a condition based on a nur​​​sing diagnosis.

The Regulation does not refer to RPNs preventing conditions; however, preventing conditions is a routine part of practice for RPNs.

The restricted activities associated with assessing and treating conditions may involve inserting devices, fingers, hands or solutions into the body. Examples of psychiatric nursing activities involving the restricted activities listed below are:

  • Taking a rectal temperature (assessing).
  • Performing digital rectal exams or stimulation, or giving an enema (assessing, treating a condition).
  • Catheterizing a client with urinary retention caused by medication (treating a condition).
  • Performing a pelvic exam (assessing).
  • Suctioning a client with an established tracheostomy (treating a condition).
  • Checking patency of ear drum using an otoscope (assessing).
  • Removing wax from the external ear canal using water and a bulb syringe (treating a condition).
  • Flushing a nasogastric tube or ​​enteral tube following a feed (preventing a condition).​​

Assessing and Treating: Irrigation or Enteral Instillation ​

Nurses (Registered Psychiatric) Regulation, section 6(f):

A registrant in the course of practising psychiatric nursing may, for the purpose of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, administer a solution:

​i.​
by irrigation, or
​ii.
by enteral instillation​

​BCCNM limits ​​and c​onditions

1.​
RPNs must act with a client-specific order from a listed health professional to irrigate a bladder.
​2.
RPNs are limited to administering a solution through enteral instillation to clients with stable and predictable physiological health.​​


Stable​ and predictable physiological health means the degree to which a client’s condition is likely to change.​​

Assessing and Treating: Inserting Instrument, Hand or Finger ​​​

Nurses (Registered Psychiatric) Regulation, section 6(g):

A registrant in the course​​ of practising psychiatric nursing may, for the purpose of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put an instrument or a device, hand or finger

​i.​
into the external ear canal, up to the eardrum​

​BCCNM limits ​​and c​onditions

None. But see section 6(i)(i) and (ii)“Extern​​al Ear Canal” for limits and condition related to syringing an ear with air and water. ​

Nurses (Registered Psychiatric) Regulation,​​ section 6(g):

​ii.​
…beyond the point in the nasal passages where they normally narrow
​​

​BCCNM limits ​​and c​onditions

1.​
RPNs must follow a decision support tool approved by their employer when carrying out nasopharyngeal suctioning. 
​2.
RPNs are limited to re-inserting previously established nasogastric tubes (e.g., replacing a blocked tube). Initial insertion of a nasogastric tube requires a client-specific order from a listed health professional. ​

Nurses (Registered Psychiatric) Regulation, section 6(g):

​iii.​
…beyond the pharynx ​

​BCCNM limits ​​and c​onditions

1.​
RPNs must not carry out endotracheal intubation. 

Nurses (Registered Psychiatric) Regulation, section 6(g):

​iiii.​
…beyond the opening of the urethra ​

​BCCNM limits ​​and c​onditions

1.​
RPNs must follow a decision support tool approved by their employer when inserting or flushing a catheter.
 

Nurses (Registered Psychiatric) Regulation, section 6(g):

​v.​
…beyond the labia majora ​

​BCCNM limits ​​and c​onditions

1.​

RPNs who carry out pelvic exams or cervica​​​l cancer screening must 

  • successfully complete additional education and 
  • ​possess competencies outlined in Core Nursing Practice Competencies for Pelvic Exams1 (for Registered Nurses) established by the Provincial Health Services Authority (PHSA) or equivalent approved by their employer.​
​2.
RPNs who carry out pelvic exams or cervical cancer screening must follow the Decision Support Tool for Registered Nurses: Pelvic Exam2 established by PHSA or an equivalent approved by their employer. ​

Nurses (Registered Psychiatric) Regulation, section 6(g):

​vi.​
…beyond the anal verge

​BCCNM limits ​​and c​onditions

None.  ​

Nurses (Registered Psychiatric) Regulation, section 6(g):

​vii.​

…into an artificial opening into the body​

​BCCNM limits ​​and c​onditions

1.​
RPNs are limited to inserting suprapubic and gastrostomy tubes in clients with stable and predictable physiological health.
2.
RPNs are limited to carrying out ostomy care for clients with stable and predictable physiological health. 
​3.
RPNs are limited to carrying out tracheostomy care for clients with stable and predictable physiological health​. ​

Stable a​​​​nd predictable physiological health means the degree to which a client's condition is likely to change.

​Assessing and Treating: External Ear Canal​

Nurses (R​​egistered Psychiatric) Regulation, section 6(h):

A registrant in the course of practising psychiatric nursing may put a wearable hearing instrument, or a part or accessory of it, into the external ear canal, up to the eardrum​.

​BCCNM limits ​​and c​onditions

None.  ​

Nurses (Registered Psychiatric) Regulation, section 6(i)​:

A registrant in the course of practising psychiatric nursing may, for the purpose of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put into the external ear canal, up to the eardrum,

​i.​
air that is under pressure no greater than that created by the use of an otoscope, or
​ii.
​water that is under pressure no greater than that created by the use of an ear syringe/bulb.​

​BCCNM limits ​​and c​onditions

1.​
RPNs must not syringe an ear with any device that creates greater pressure than an ear bulb.
2.
​RPNs must successfully complete additional education to syringe ears with a syringe/bulb​.

The Regulation makes a distinctio​​n between syringing ears using pressure no greater than the pressure created by the use of an ear bulb syringe and syringing ears using greater pressure. ​

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